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Strictureplasty in selected Crohn's disease patients results in acceptable long-term outcome
Felipe Bellolio1, Zane Cohen, Helen M MacRae
1Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada.
Background:
Strictureplasty is an alternative to resection in patients with Crohn's disease.
Objective:
The objective of this study was to evaluate the long-term results of patients who have undergone strictureplasty.
Design:
This is a retrospective cohort study.
Setting:
This study was conducted at a tertiary referral center, Mount Sinai Hospital, Toronto, Ontario, Canada.
Patients:
All patients who had a strictureplasty of the small bowel between 1985 and 2010 were identified from a prospective database.
Main Outcome Measures:
The main outcomes were short-term complications, need for further surgery, and surgery-free survival. Multivariate analysis was performed to determine factors affecting the need for further surgery. Quality of life was measured by use of the short version of the Inflammatory Bowel Disease Questionnaire.
Results:
Ninety-four patients (42 women; age at first strictureplasty, 33.4 ± 9.7 years) underwent 119 operations (range per patient, 1-4). The number of strictureplasties was 278 (range, 1-11), including 9 in the duodenum and 269 in the jejunum-ileum. The most common type of procedure was the Heineke-Mickulicz (258, 92.8%). Median follow-up of the patients was 94 months (interquartile range, 27-165 months). The surgery-free survival at 5 and 10 years was 70.7% (95% CI 59.8, 81.7) and 26.6% (95% CI 13.6, 39.6). In multivariate analysis, only age at the time of first strictureplasty was associated with the need for further surgery. Fifty-seven (64.8%) patients returned the questionnaire. The average score was 5.2 ± 1.2 (range, 2.2-7.0) with no significant differences between patients with or without previous surgery (p = 0.22), with or without simultaneous resection (p = 0.71) or with or without further surgery (p = 0.11).
Limitations:
This study was limited by its sample size and retrospective design.
Conclusions:
Strictureplasty is a safe procedure with acceptable long-term outcomes. The risk of needing further surgery is high, which reflects the complexity of this disease. Younger age is associated with a higher risk of need for further surgery. However, most patients have a satisfactory quality of life.
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